Health Promotion: The toddler and the preschooler

Question 1

Which is the priority nursing action when performing a physical assessment on a toddler?
1. Leaving intrusive procedures such as eye and ear examinations until the end
2. Explaining each part of the examination to the child before performing it
3. Performing the assessment from head to toe
4. Asking the mother to tell the child not to be afraid

Answer 1

1. Leaving the intrusive procedures such as eye and ear examinations until the end
   Explanation:
2. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should
   be done last to decrease the anxiety of the child during the initial phases of the
   examination, which include heart and lungs.
3. A toddler is too young to understand the medical terminology.
4. Intrusive procedures such as examinations of the eyes, ears, throat, and genitals should
   be done last to decrease the anxiety of the child during the initial phases of the
   examination, which include heart and lungs.
5. Asking the mother to tell the child not to be afraid is an inappropriate response.

Question 2

At which age will the nurse begin to calculate body mass index (BMI) as a part of the
nursing assessment process?
1. 12 months
2. 18 months
3. 2 years
4. 4 years

Answer 2

3. 2 years
   Explanation:
4. While the nurse will plot a child’s growth at 12 months of age a BMI is not included in
   the physical assessment at this time.
5. While the nurse will plot the child’s growth at 18 months of age, a BMI is not included
   in the physical assessment at this time.
6. BMI is first calculated at 2 years of age, and gives information about the relationship
   between the height and weight of the child. With this information, the nurse would be
   able to develop strategies that can reduce the incidence of obesity.
7. The nurse will not initiate BMI calculation for a 4 year old; this action should be
   implemented into the nursing assessment prior to 4 years of age.

Question 3

During a well-child visit with a 4-year-old girl the nurse notes that the parents speaks
harshly to the child and used negative remarks when speaking with the nurse. Which
statement by the nurse would be beneficial in this situation?
1. “Perhaps you should leave the room so that I can speak with your child privately.”
2. “I am going to refer you for counseling since your interactions with your child seem so
negative.”
3. Addressing the child, the nurse says, “Are you unhappy when mommy talks to you like
this?”
4. “Let’s talk privately. We should discuss the way you speak with your child and possible
ways to be more positive.”

Answer 3

4. Lets talk privately. We should discuss the way you speak with your child and possible ways to be more positive :)”
   Explanation:
5. Since the child is only 4 years old, it would be difficult to ask the parent to leave the
   room. If the nurse wants to speak alone with the child, it would be best to escort the
   child to another area and speak briefly with the child.
6. Referring to counseling without a discussion with the parent is not appropriate.
7. The nurse should not ask the child if she is “unhappy” with the parent.
8. The best approach to this encounter would be for the nurse to discuss concerns with the
   parent privately, since the nurse wants to help the parent develop a good relationship
   with the child. The child should not be a part of this conversation.

Question 4

Which action by the nurse is appropriate when teaching the parents of a 2-year-old child
during a scheduled health maintenance visit?
1. Encouraging the parents to allow the child to pour liquids using a pitcher
2. Being sure that all major foods group have been introduced to the child
3. Teaching the parents that it is appropriate to switch from whole to 2% milk
4. Educating the child about food groups

Answer 4

3. Teaching the parents that it is appropriate to switch from whole to 2% milk.
   Explanation:
4. It is not appropriate to encourage the parents to allow the child to pour liquids using a
   pitcher until 3 years of age.
5. The nurse should ensure that all major foods groups have been introduced to the child at
   1 year of age.
6. The nurse will teach the parents that it is appropriate to switch from whole to 2% milk
   during the 2-year-old’s health maintenance visit.
7. The nurse would not educate the child about food groups until the age of 4 years.

Question 5

The visiting nurse is evaluating the home environments of several preschool-age children as
they relate to child safety. The nurse visits the home of each child and gathers the following
data. Which activity noted during the visit places a child at the greatest risk for bodily
harm?
1. The parents are in a methadone program.
2. The parents consume alcohol on a daily basis.
3. The child watches television for 2 hours each day.
4. The child is permitted to swim in the family pool unsupervised.

Answer 5

4. The child is permitted to swim in the family pool unsupervised
   Explanation:
5. Drug and alcohol use or past use places the child at risk; however, this is not the priority
   risk assessed.
6. Drug and alcohol use or past use also place the child at risk; however, this is not the
   priority risk assessed.
7. A child who is allowed to watch excessive amounts of television each day is at risk for
   obesity and other health problems; however, this is not the priority risk assessed.
8. A child should be supervised while swimming at all times. This observation places the
   child at the greatest risk for bodily harm.

Question 6

The parents of a 2-year-old girl inquire about information to help their child transition to
bed each night. Which response by the nurse is appropriate?
1. Let the child cry self to sleep a few nights to adjust to the transition.
2. Play a favorite video at bedtime on a television in the child’s room to enhance
relaxation.
3. Read a book to the child just before bedtime each night.
4. Let the child fall asleep while playing and then put the child in bed.

Answer 6

3. Read a book to the child just before bedtime each
   Explanation:
4. A child of this age will not just learn to fall asleep on her own if left alone. Letting the
   child cry for an extended period of time can affect attachment issues.
5. Having a television in a 2-year-old child’s room is not a healthy practice. This can lead
   to decreased physical activity.
6. Developing a quiet routine just before bedtime can help calm the child and give an
   expectation to what will happen next: going to bed.
7. Letting the child fall asleep while playing is not healthy, as it allows the child to get to
   the point of exhaustion without any limits set.

Question 7

Parents of a preschool-age child report that they find it necessary to spank the child at least
once a day. Which response by the nurse is appropriate based on this information?
1. “Can you try spanking the child only every other day for 1 week and see how that
affects your child’s behavior?”
2. “Spanking is one form of discipline; however, you want to be sure that you do not leave
any marks on the child.”
3. “I think you are not parenting properly, so let’s talk about ways to improve your
parenting skills.”
4. “Let’s talk about other forms of discipline that have a more positive effect on the child.”

Answer 7

4. “Let’s talk about other forms of discipline that have a more positive effect on the child.”

Question 8

Which parental statement during a scheduled health maintenance assessment for a preschool-
age child would cause the nurse concern?
1. “We have dinner together as a family each evening.”
2. “We are so proud that our child is able to recognize letters of the alphabet.”
3. “Our child wakes up each night screaming because of nightmares.”
4. “Our child attends a daycare program 3 days per week.”

Answer 8

3. “Our child wakes up each night screaming because of nightmares.”
   Explanation:
4. Parents are encouraged to spend time with their children each day. The statement about
   eating dinner together each evening as a family would not cause the nurse concern.
5. A preschool-age child should be able to recognize letters of the alphabet. Parents who
   verbalize pride in their child would not cause the nurse concern.
6. A child who awakens each night due to nightmares may be indicative of a mental
   illness. This statement would cause the nurse concern.
7. Many children attend daycare due to both parents in the house working. The nurse
   should further assess the interactions between the parents and the caregivers; however,
   this statement would not cause the nurse concern.

Question 9

Which immunization will the nurse provide parental education during the health maintenance
visit for a 4-year-old child?
1. Hepatitis B #3
2. Haemophilus influenzae type B #2
3. Inactive poliovirus #3
4. Measles, mumps, and rubella #1

Answer 9

3. Inactive poliovirus #3
   Explanation:
4. The third hepatitis B vaccine is administered between 6 and 18 months of age.
5. The second Haemophilus influenzae type B vaccine is administered 6 months after the
   first vaccine, which is scheduled at 12 months of age.
6. The third inactive poliovirus vaccine is often administered between 4 and 6 years of age.
   The nurse would provide parental education during the health maintenance visit.
7. The first measles, mumps, and rubella vaccine is administered between 12 and 15
   months of age.

Question 10

The nurse is teaching the parents of a toddler-age child about injury prevention. Which
statement by the parent indicates the need for further education?
1. “I will turn the handles of the pots outward while I am cooking dinner.”
2. “We will make sure that our child always wears a life vest when we are out in the boat.”
3. “I will keep all our medications out of reach and ensure child-resistant containers.”
4. “We will provide safe climbing toys for our child.”

Answer 10

1. “I will turn the handles of the pots outward while I am cooking dinner.”
   Explanation:
2. Handles of the pots should be turned inward and not outward to prevent toddler injury.
   This statement indicates the need for further education.
3. A life vest should be worn by the toddler when near water or on a boat. This statement
   indicates correct understanding of the information presented.
4. All medications should be kept out of reach from the toddler and the parents should
   ensure child-resistant containers are used. This statement indicates correct
   understanding of the information presented.
5. Parents should supervise toddlers closely and provide safe climbing toys for the child.
   This statement indicates correct understanding of the information presented.

Question 11

Which assessment finding for a toddler-age child indicates an increased risk for an unhealthy
self-concept?
1. A parent who praises the child for his or her accomplishments
2. A parent who is attempting potty training but who understands that accidents will
happen
3. A parent who is observed spanking a child for taking a toy from another child in the
waiting room
4. A parent who reads a book to the toddler-age child each night before bed to encourage
cooperation

Answer 11

3. A parent who is observed spanking a child for taking a toy from another child in the waiting room

Question 12

The nurse is teaching the parents of a toddler-age child information regarding toy and
playground safety. Which parental statement indicates the need for further education?
1. “I allow my child to play with the packaging material for new toys.”
2. “I will avoid buying my child toys that are battery operated.”
3. “I allow my child to play with age-appropriate toys as indicated on the packaging.”
4. “I don’t let my child play on the playground without supervision.”

Answer 12

1. “I will allow my child to play with the packaging material for new toys.”

Question 13

The nurse is planning health promotion activities for a toddler-age child during a scheduled
health maintenance visit. Which action by the nurse is appropriate during this visit?
1. Connecting developmental skills with risks for injury
2. Recognizing that childcare attendance increases the risk for communicable disease
3. Planning education for treatment of common disease processes
4. Illustrating developmental progression on a screening tool

Answer 13

4. Illustrating developmental progression on a screening tool.
   Explanation:
5. Connecting developmental skills with risks for injury is an action that prevents disease
   and injury. This is not a health promotion activity.
6. Recognizing that attendance at a daycare center increases the risk for communicable
   disease is an action that prevents disease and injury. This is not a health promotion
   activity.
7. Planning treatment for common disease processes is an action that prevents disease and
   injury. This is not a health promotion activity.
8. Illustrating developmental progression on a screening tool is a health promotion action.

Question 14

Which action should the nurse include when providing education regarding methods to
enhance health promotion during a scheduled health maintenance visit for a 4-year-old
child?
1. Recognizing that food jags are common
2. Involving the child in snack selection and preparation
3. Encouraging the use of a highchair with a safety strap
4. Recommending the child consumes high-fat foods

Answer 14

2. Involving the child in snack selection and preparation
   Explanation:
3. Food jags are not common for a 4-year-old child. This is more common for the 2-year-
   old child.
4. A 4-year-old child should be involved in snack selection and preparation.
5. The use of a highchair with a safety strap is not information that should be included for
   a 4-year-old child during a health maintenance visit. This is more appropriate for a
   toddler-age child.
6. Low-fat, not high-fat, foods should be encouraged during the health maintenance visit.

Question 15

15) The nurse is conducting a physical assessment for a preschool-age child. When plotting the
child’s body mass index (BMI) the nurse notes that the child’s is at the 90th percentile.
Which action by the nurse is appropriate?
1. Referring the child to a nutritionist
2. Conducting a developmental assessment
3. Assessing the child’s level of activity
4. Checking a blood glucose level

Answer 15

3. Assessing the child’s level of activity.

Question 16

Which will the nurse assess in the family of a 3-year-old child during a pediatric clinic visit
scheduled due to regressive behavior? Select all that apply.
1. Change in parental marital status
2. Level of education for each parent
3. Health of child’s siblings
4. Maternal depression
5. Child’s exposure to communicable diseases

Answer 16

1. Change in parental marital status
2. Health of child’s siblings
3. Maternal depression
   Explanation:
4. Changes that occur with the family members of a 3-year-old child could be the source of
   the regressive behavior being exhibited. It is appropriate for the nurse to assess for a
   change in parental marital status.
5. The nurse would not need to assess the level of education for each parent for a 3-year-
   old child exhibiting regressive behavior. This information will already be compiled in
   the child’s medical record.
6. A change in the health of the child’s siblings could cause regressive behavior. This is
   appropriate for the nurse to include in the family assessment.
7. Maternal depression can be associated with poor self-concept and could be a reason for
   regressive behavior. This is appropriate for the nurse to include in the family
   assessment.
8. While it is appropriate for the nurse to assess the child’s exposure to communicable
   disease, this is not included in the family assessment for regressive behavior.

Question 17

Which assessment questions are appropriate when the nurse is assessing the mental health of
a preschool-age client? Select all that apply.
1. “Is your child experiencing nightmares?”
2. “Does your child ask questions about the genitalia?”
3. “How do you implement punishment for your child when a rule is broken?”
4. “Is your child up-to-date on recommended immunizations?”
5. “Does your child wear safety equipment when riding a bicycle?”

Answer 17

1. “Is your child experiencing nightmares?”
2. Does your child ask questions about the genitalia?”
3. “How do you implement punishment for your child when a rule is broken?”
   Explanation:
4. The nurse inquires about nightmares when assessing the mental health of a preschool-
   age client.
5. The nurse inquires about sexual exploration when assessing the mental health of a
   preschool-age client.
6. The nurse inquires about implementing punishment for broken rules when assessing the
   mental health of the preschool-age client.
7. Assessing immunization status is not included in a mental health assessment for a
   preschool-age client.
8. Assessing the use of safety equipment is not included in a mental health assessment for
   a preschool-age client.

Question 18

Which nursing actions are appropriate when conducting a mental health assessment for a
toddler-age child? Select all that apply.
1. Observing the child’s interaction with family members
2. Asking the caregiver to describe the child’s typical day
3. Giving the child a crayon to assess ability to use
4. Determining the number of hours the child sleeps each night
5. Inquiring about recent exposure to communicable diseases

Answer 18

1. Observing the child’s interaction with family members.
2. Asking the caregiver to describe the child’s typical day.
3. Giving the child a crayon to assess ability to use.
4. Determining the number of hours the child sleeps each night.

Question 19

Which interventions will the nurse recommend for a toddler-age client who is biting other
children at daycare? Select all that apply.
1. Using a time-out as a form of discipline for the child’s behavior
2. Separating the child from the situation
3. Telling the child it is not okay to hurt another person
4. Inquiring whether the child is getting enough sleep
5. Implementing distraction to avert the behavior

Answer 19

1. Using time-out as a form of discipline for the child’s behavior.
2. Separating the child from the situation
3. Telling the child it is not okay to hurt another person.
4. Inquiring whether the child is getting enough sleep.
   Explanation:
5. A time-out is an appropriate intervention for the nurse to suggest when a toddler-age
   child is exhibiting behaviors that include other people, such as biting.
6. Separation of the child from the situation is an appropriate intervention for the nurse to
   suggest when a toddler-age child is exhibiting behaviors that include other people, such
   as biting.
7. It is appropriate to encourage the parents to tell the child that the behavior is
   unacceptable when the child is exhibiting behaviors that include other people, such as
   biting.
8. When a child is exhibiting behaviors that include other people, such as biting, it is
   appropriate to assess the amount of sleep the child is getting each night. Lack of sleep is
   a common cause for behaviors such as biting.
9. Distraction is appropriate behavior for undesirable behaviors exhibited by the child; however this is not an appropriate when the child is exhibiting behaviors that include other people, such as biting.

Question 20

Which recommendations will the nurse make to the parents of a preschool-age child who is
experiencing frequent nightmares? Select all that apply.
1. Reassure the child by back rubbing.
2. Repeat a nighttime routine, such a reading a story.
3. Bring the child to the parental bed.
4. Allow the child time to settle back into sleep.
5. Place a television in the child’s room for distraction.

Answer 20

1. Reassure the child by back rubbing.
2. Repeat a nighttime routine, such as reading a story.
3. Allow the child time to settle back into sleep